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Ultrasound-guided bilateral rectus sheath block reduces early postoperative pain after laparoscopic gynecologic surgery: a randomized study

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Abstract

Purpose

Rectus sheath block (RSB) is an anterior abdominal wall block that reduces postoperative pain associated with midline incisions. This study aims to investigate the effect of ultrasound-guided bilateral RSB (US-BRSB) on postoperative pain and analgesic consumption in patients undergoing laparoscopic gynecologic surgery.

Methods

Sixty patients who underwent laparoscopic gynecologic surgery were allocated to RSB (n = 30) or control (n = 30) group. A bilateral US-BRSB procedure (30 ml of 0.25% ropivacaine) was performed after induction of general anesthesia in the RSB group. The control group proceeded the surgery without sham block. All patients received fentanyl-based intravenous patient-controlled analgesia and rescue analgesics upon demand. Pain was scored by a blinded observer using a verbal numerical rating scale (VNRS) at rest while coughing at 0, 1, 6, 12, 24, and 48 h after postanesthesia care unit (PACU) admission. The primary outcome was the total number of rescue analgesics used in the 48-h postoperative period.

Results

At 0 h, VNRS were lower in the RSB group than in the control, both at rest (median VNRS 4.5 vs. 5, p = 0.02) and while coughing (median VNRS 6 vs. 7, p = 0.004). At 6 h, VNRS scores were lower in the RSB group than in the control while coughing (median VNRS 3 vs. 5, p = 0.01). Fentanyl use as rescue analgesics in the PACU was significantly lower in the RSB group than in the control (27.7 ± 32.1 vs. 53.3 ± 33.7 µg, respectively; p = 0.004). At 48 h postoperatively, the total number of rescue analgesics administered were significantly fewer in the RSB group than in the control (2.5 ± 2.5 vs. 3.9 ± 2.6, respectively; p = 0.04).

Conclusion

US-BRSB reduces the immediate postoperative pain and opioid consumption during the early postoperative period.

ClinicalTrials.gov identifier

NCT02476799, https://clinicaltrials.gov/ct2/show/NCT02476799.

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Authors and Affiliations

  1. Department of Anesthesia and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea

    Sooyoung Cho & Youn Jin Kim

  2. Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea

    Kyungah Jeong & Hye-Sung Moon

Authors
  1. Sooyoung Cho
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  2. Youn Jin Kim
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  3. Kyungah Jeong
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  4. Hye-Sung Moon
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Corresponding author

Correspondence to Youn Jin Kim.

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The authors report no conflict of interest.

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Additional information

Paper presentation information: “2014 Seoul International Conference of Anesthesiology in conjunction with the 91st Annual Scientific Meeting of the Korean Society of Anesthesiologists”, Seoul, Korea, November 6–8, 2014.

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Cho, S., Kim, Y.J., Jeong, K. et al. Ultrasound-guided bilateral rectus sheath block reduces early postoperative pain after laparoscopic gynecologic surgery: a randomized study. J Anesth 32, 189–197 (2018). https://doi.org/10.1007/s00540-018-2457-0

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  • DOI: https://doi.org/10.1007/s00540-018-2457-0

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